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Uretroplastia Termino-Terminal para El Tratamiento
Uretroplastia Termino-Terminal para El Tratamiento
Uretroplastia Termino-Terminal para El Tratamiento
2016;76(5):275---278
www.elsevier.es/uromx
ARTÍCULO ORIGINAL
División de Urología, Hospital General «Dr. Manuel Gea González», Ciudad de México, México
∗ Autor para correspondencia. Calzada de Tlalpan 4800. Colonia Sección XVI Delegación Tlalpan, Ciudad de México. CP 14080.
Teléfono 4000-3000, Ext 3298.
Correo electrónico: drtrujillo68@gmail.com (L. Trujillo Ortiz).
http://dx.doi.org/10.1016/j.uromx.2016.06.001
2007-4085/© 2016 Sociedad Mexicana de Urologı́a. Publicado por Masson Doyma México S.A. Este es un artı́culo Open Access bajo la licencia
CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).
276 L. Trujillo Ortiz et al.
KEYWORDS End-to-end urethroplasty for the primary treatment of urethral stricture: experience
Stricture; at the Hospital General Dr. Manuel Gea González
Urethra;
End-to-end Abstract
urethroplasty Background: Urethral stricture is a urologic disease that has significant morbidity. Direct visual
internal urethrotomy is used for the majority of cases in the United States, but end-to-end ureth-
roplasty is the most successful technique. The choice of primary management is controversial.
Direct visual internal urethrotomy is widely accepted in the majority of Mexican hospital cen-
ters. However, it is reported to have lower long-term success rates. Urethroplasty is indicated
for long, densely fibrotic strictures. Diagnosis is based on radiologic studies (nuclear magnetic
resonance or ultrasound, with contrast medium). Scales (Urethral Stricture Score) describing
stricture complexity are employed to choose surgical treatment.
Aims: To communicate the results of primary treatment for urethral stricture in patients at the
Hospital General Dr. Manuel Gea González that underwent end-to-end urethroplasty.
Materials and Methods: A descriptive study was conducted that reviewed the case records of
210 patients with urethral stricture, selecting the 58 cases that underwent end-to-end ureth-
roplasty as primary treatment within the time frame of January 1, 2007 and December 31,
2013.
Results: The median age of the patients was 46.4 years. Stricture etiology: traumatic 23%,
iatrogenic 58%, idiopathic 17%, and infectious 2%. The most frequent stricture location was
at the bulbar level (87.9%) (51), mean length was 2.12 cm, 3 cases presented with double-site
stricture, 11% (19) of the cases had urinary retention, and the mean urethral stricture score was
5.8. There were 10 recurrences, 9 re-interventions (urinary tract infection), and one augmented
urethroplasty. Preoperative Qmax was 5.7-10 ml/sec and postoperative Qmax was 13-16 ml/sec.
Cure was achieved in 82.7% of the cases.
Conclusions: Urethroplasty success rates worldwide are reported at 84-97%. Results are related
to stricture complexity and surgical experience. There is still no consensus on success parame-
ters. Urethroplasty presents less recurrence compared with direct visual internal urethrotomy,
promoting long-term quality of life.
© 2016 Sociedad Mexicana de Urologı́a. Published by Masson Doyma México S.A. This is an open
access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/
4.0/).
60
Doble
50
40
Peniano
30
20 Membranosa
10
Bulbar
0
Traumática Iatrógena Idiopática Infecciosa 0 10 20 30 40 50 60
Figura 1 Etiología de estenosis de uretra (porcentaje). Figura 2 Localización de segmento estenótico (n.◦ ).
Tabla 1 Resultados
Parámetro Pacientes (n◦ ) Porcentaje (%) Rango Mediana
Longitud (cm) 1 - 3.5 2.12
RAO 11 19
USS 5.8
Recurrencia 10
Qmáx prequirúrgico (ml/s) 5.7 - 10
Qmáx posquirúrgico (ml/s) 13 - 16
Éxito (cura) 48 82.7
278 L. Trujillo Ortiz et al.
En este estudio demostramos que la uretroplastia término- Los autores declaran no tener ningún conflicto de intereses.
terminal debe ser considerada como primera opción de
manejo, por lo que es importante el entrenamiento en este Bibliografía
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de vida a largo plazo. 2010.
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